RES 2002-2533 - Appoint Michele D Hagen manager of Musette Bar STATE OF NEBRASIEu
zas eT\ l tg 3 NEBRASKA LIQUOR CONTROL COMMISSION
b t ` 0,� cc1 2 A+. 7 Forrest D. Chapman
Executive Director
W•' '� ah b1%I 301 Centennial Mall South,5th Floor
lEirlritr m CLERK P.O.Box 95046
%�,O. i' i C V T Y r, Lincoln,Nebraska 68509-5046
.,1�1j'! t� BRAS1' ' Phone(402)471 2571
`�RCB Sv�S.
October 18, 2002 Fax(402)471-2814
TRS USER 800 833-7352(TTY)
Mike Johanns web address:http://www.nol.org/home/NLCC/
Governor
City Clerk of Omaha
1819 Farnam LC1
Omaha, NE 68183 •
RE: Manager Application Submittal
Dear Sir/Madam:
The 5918, Inc. DBA Musette Bar has submitted the enclosed Application for
Corporate Manager. Musette Bar has the following liquor license C #15034 and is
located at 6620Maple Street, Omaha, NE 68104 (Douglas County). The applicant's
name is Michele D. Hagen.
Please present this application to your City/County Council and return the
results of the action taken to our office. If you have any questions or comments,
please give me a call at (402) 471-4881.
Sincerely,
AI '23. 722 /M)7paliditdD 1
Jackie B. Matulka
Licensing Division
Enclosure
Rhonda R. Flower Bob Logsdon R.L. (Dick) Coyne
Commissioner Chairman Commissioner
An Equal Opportunity/Affirmative Action Employer
Printed with soy ink on recycled paper
LocaQL`jbrYm .
Application for Corporate Mana ^
O *Must Be A Nebraska Resident* E` j E I V E D
Please submit in Triplicate •
Return to: Nebraska Liquor Control Commission,PO Box 95046 OCT 18 2002
301 Centennial Mall So.,Lincoln NE 68509
Phone: (402)471-2571 Fax: (402)471-2814 Web address: http://www.nol.org/home/NLCC/
NEBRASKA LIOUOP
LIQUOR LICENSE INFORMATION CONTROL COMMISSION
NAME OF LICENSED CORPORATION CLASS&LICENSE NUMBER
5-q IS N . c 15O3V
TRADE NAME OF LICENSED PREMISE
rn OS e,He 84 r
STREET ADDRESS OF LICENSED PREMISE CITY COUNTY ZIP CODE
&oZ o map'e ntriccha N uj/6 5 bEias
On behalf of the corporation,I llesignate this individual as corporate manager. 0.
Signature of Corporate President/CEO: �w yt�' lY_k
APPLICANT INFORMATION (MUST BE 21 OR OVER)
NAME(LAST,FIRST,MIDDLE,MAIDEN) SEX I SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF BIRTH
M
(i)Px rn rh - .Pie 1 , }, , - - ., t 0--1- Onh
HOME O2EET( Wit
ADDR CITY COUNTY STATE ZIP CODE
1o(p / L Si. . OMc--h DO
a vc /6, C JU O90,O0
HOME TELEPHONE NUMBER BUSINESS TELEPHONE NUMBER (....) DRIVERS LICENSE NUMBER&STATE
(1/G)) ( t9 — 0,4350 ( Lf(12) 5/- �' -3O CEO 1 / Cl Ll1C)s' - AJE
SPOUSE'S INFORMATION (IF NOT MARRIED INDICATE NONE)
FULL NAME(LAST,FIRST,MIDDLE,MAIDEN) SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER
J &STATE
e____
...________
DATE OF BIRTH: .r-- PLACE OF BIRTH:
1. READ CAREFULLY—Answer completely and accurately.
Has anyone who is a party to this application or their spouse,ever been convicted of or plead guilty to any criminal charge?Criminal
charge means any charge alleging a felony or misdemeanor violation of a federal or state law; or a violation of a local law, ordinance or
resolution. List the nature of the charge, where the charge occurred and the year and month of the conviction or plea.Also list any
charges pendin at the time of this application. If more than one party,please list charges by each individual's name.
❑ YES J NO
2. Have you or your spouse ever made application for any liquor license or manager for any liquor license?IF YES,for what premise
give license number and date. *— '. _r
❑ YES x1 NO 1 .
FORM 35-4013
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A
3. Have you or your spouse ever made a compromise settlement for violation of such laws? a
CI YES lX NO )' ,J�
4. Do you,as a manager,have all the qualifications required by any person entitled to hold a Nebraska Liquor License?
Nebraska Liquor Control Act(§53-1.31.01)
"1 YES ❑ NO
5. Have you filed fingerprint cards and PROPER FEES(if check,made out to the NE State Patrol),with this application?
[ YES ❑ NO prin{-s on - 1 le a. -c,202- - Dc
LIST PRINCIPAL RESIDENCE FOR PAST 10 YEARS,APPLICANT AND SPOUSE MUST COMPLETE
APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR
FROM TO FROM TO
(P(olLi W/ 0424A0i S s oa none
EMPLOYERS—LIST LAST TWO EMPLOYERS
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
)qq& Pry-Se/f 5 / ..L NC 1 \. , 1--(1 qqz-SSzl- 53o
19C3 2Co Me COMP/Iv(' �',D n f,vnl' 1,av►ic 402- 61s7- ,27Y)
PERSONAL OATH AND CONSENT OF INVEST GATION MUST BE SIGNED BY APPLICANT &SPOUSE
STATE OF NEBRASKA )
) SS
COUNTY OF )
The above individual(s),being first duly sworn upon oath,deposes and states that the undersigned is the applicant and/or spouse of applicant who makes the above and foregoing
application,that said application has been read and that the contents thereof and all statements contained therein are true.If any false statement is made in any part of this
application,the applicant(s)shall be deemed guilty of perjury and subject to penalties provided by law.(Sec.§53-131.01)Nebraska Liquor Control Act.
The undersigned applicant hereby consents to an investigatioti of his/her background including all records of every kind and description including police records,tax records
(State and Federal),and bank or lending institution records,and said applicant and spouse waive any rights or causes of action that said applicant or spouse may have against
the Nebraska Liquor Control Commission and any other individual disclosing or releasing said information to the Nebraska Liquor Control Commission.If spouse has NO
interest directly or indirectly,an affidavit may be attached however,fingerprint cards are still required to be filed.
The undersigned understand and acknowledge that any license issued, based on the information submitted in this application, is subject to cancellation if the information
contained herein is incomplete and inaccurate.
. //j /4 , _
Signature of Appli t Signature of Spouse(if applicable)
Subscribed in my presence and sworn to before me this 1 ) ' Subscribed in my presence and sworn to before me this
day of ('X 4rC"‘YJ Y day of
GENERAL NOTARY State of Nebraska
gA')f, ,....OJU)
ROSE...,` My comm.Exp.Oec.25,2 E
C;ttoli
Notary Signature&Seal Notary Signature&Seal
FORM 35-4013
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OMNHA, �'F
City o Omaha Ne bras :�° ��I' =�'s�
liail
1819 Farnam —Suite LC 1 n® r !C�.�. -. 1
Omaha, Nebraska 68183-0112 o,•.r �: ,•r_ - "��'
Buster Brown (402) 444-5550 .o ev-
City Clerk FAX (402) 444-5263 0�'�ED FEBRv�4-
October 22, 2002
5918, Inc. Application to appoint Michele D. Hagen
Dba"Musette Bar" manager of your present Class "C" Liquor
6020 Maple Street License
Omaha,NE 68104
Dear Liquor License Applicant:
This letter is notification that a hearing before the Omaha City Council on your
application to appoint a manager to the liquor license has been set for November 5, 2002.
The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4),
Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council
Liquor Rule No. 6 states, "Each applicant for any type of license shall be personally
present in the Council Chambers, in order that the Council may make inquiries, on the
date of public hearing of the application for said license". Failure to be present at this
Council Meeting is grounds to recommend denial of your application to the Nebraska
Liquor Control Commission.
City Council Rule No. 14, requests each applicant to submit a signed statement
representing that a sign indicating the birth date for buyers of alcohol will be prominently
displayed on the licensed premises and that approved training in the proper procedures
for checking buyers' identification will be provided to employees. Attached is the
statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's Office
before your public hearing. FOR YOUR FILE,ATTACHED SENT TO MANGER.
Sincerely yours,
Cho
ster Brown
City Clerk
BJB:clj
OMAH�'
CityofOmaha, Nebras a ��° ‘�' Aft°4 . *
1819 Farnam—Suite LC 1 S® iK 4`►
Omaha, Nebraska 68183-0112 ).•.w - ,�� '•
Buster Brown (402) 444-5550 .o tiv
City Clerk FAX (402) 444-5263 o4, FEBRu"
October 22, 2002
Michele D. Hagen Application to be appointed manager of the
6614 Wirt Street Class"C" Liquor License for 5918, Inc.,
Omaha,NE 68104 dba"Musette Bar", 6020 Maple Street
Dear Liquor License Manager Applicant:
This letter is notification that a hearing before the Omaha City Council on your
application to be appointed manager of the liquor license has been set for November 5,
2002. The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-
4), Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council
Liquor Rule No. 6 states, "Each applicant for any type of license shall be personally
present in the Council Chambers, in order that the Council may make inquiries, on the
date of public hearing of the application for said license". Failure to be present at this
Council Meeting is grounds to recommend denial of your application to the Nebraska
Liquor Control Commission.
City Council Rule No. 14, requests each applicant to submit a signed statement
representing that a sign indicating the birth date for buyers of alcohol will be prominently
displayed on the licensed premises and that approved training in the proper procedures
for checking buyers' identification will be provided to employees. Attached is the
statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's
Office before your public hearing.
Sincerely yours,
Buster Brown
City Clerk
BJB:clj
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